Daily bathing with disposable antimicrobial cloths reduced the rate of MRSA transmission in a geriatric facility.

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THURSDAY, June 7, 2012 — Bathing geriatric patients with disposable antimicrobial wipes cut the number of MRSA cases by 82 percent over nearly three years at a geriatric healthcare facility in Toronto, according to new research.

In addition to a cleanser, the "bath-in-a-bag" wipes used in the study contained 2 percent chlorhexidine, the same powerful antibacterial that surgeons use to scrub their hands and arms before operations. It's also used to disinfect skin before a surgical procedure or injection.

"If you take chlorhexidine and clean the skin, you can go ahead and make an injection, you can do surgery. We knew these were the short-term effects," said Chingiz Amirov, MPH, director of infection prevention and control at the Baycrest facility, which conducted the study. "We were wondering whether these baths with chlorhexidine can also offer long-term protection."

The patients each received one bath a day, from the neck down. “Generally chlorhexidine should be used on intact skin only. The skin should be in good condition, and most of our patients met this criteria,” Amirov says.

What Is MRSA?

Methicillin-resistant Staphylococcus aureus, better known as MRSA, kills about 19,000 people each year in the United States. And while MRSA can develop outside the hospital (so-called community-based MRSA), most deadly MRSA cases occur in healthcare settings, with the elderly especially at risk.

MRSA can spread via hospital linens, bed rails, bathroom fixtures, and hospital equipment, as well as through being touched or touching the skin of an infected person, according to the Centers for Disease Control and Prevention (CDC). While MRSA that develops outside the hospital most commonly affects the skin (which can appear red and swollen, like an insect bite), hospital-based MRSA can cause sepsis (blood poisoning), endocarditis (infection of the lining around the heart), necrotizing fasciitis (flesh-eating disease), or pneumonia. Signs of hospital-based MRSA include shortness of breath, fever, and chills.

All patients admitted to Baycrest are first screened for MRSA, which may be present in the body (known as colonization) without causing an infection. Patients colonized with MRSA may not be sick themselves, but they are at greater risk of developing an infection and can also pass it on to others.

The Baycrest staff determined that 21 percent of MRSA cases in the facility were occurring in the 27-bed chronic care unit, which houses critically ill patients. "Because patients who are colonized with MRSA have a much greater chance of developing a MRSA infection, we knew we needed to intervene to stop transmission and prevent infection,” Heather Candon, an infection control practitioner at Baycrest and the lead author of the study, said in a press release.

The results were presented at the Association for Professionals in Infection Control and Epidemiology (APIC) 2012 Annual Conference in Texas in early June.

Guarding Against MRSA

Meticulous hygiene practices are the best way to safeguard against MRSA, which means all doctors, nurses, and other healthcare personnel should wash their hands with soap and water or use an alcohol-based rub both before and after patient contact. Maintaining a clean environment is also important.

Other studies have examined whether bathing patients with chlorhexidine helps prevent MRSA infections. A 2012 review of seven papers on the subject concluded that washing patients with chlorhexidine may be effective in preventing bloodstream infections due to MRSA, and an earlier study published in Critical Care Medicine found that daily sponge baths with chlorhexidine reduced the risk of MRSA by 32 percent compared with those bathed with a soap-and-water solution.

"This is an additional tool for MRSA prevention within health care," says Amirov. "There's no single-control measure that's going to be 100 percent preventive. It's all about bundles — several prevention or control measures bundled together. In the case of MRSA, we're talking about health hygiene, environmental cleaning, and now body cleaning with an antiseptic agent."

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